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INDONESIA
Paediatrica Indonesiana
Published by Ikatan Dokter Anak Indonesia
ISSN : 00309311     EISSN : 2338476X     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Paediatrica Indonesiana is a medical journal devoted to the health, in a broad sense, affecting fetuses, infants, children, and adolescents, belonged to the Indonesian Pediatric Society. Its publications are directed to pediatricians and other medical practitioners or researchers at all levels of health practice throughout the world.
Arjuna Subject : -
Articles 9 Documents
 1 
Search results for , issue "Vol 46 No 1 (2006): January 2006" : 9 Documents clear
Multidrug resistance in the neonatal unit and its therapeutic implications Rinawati Rohsiswatmo
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.25-31

Abstract

Background Neonatal septicemia constitutes an important causeof morbidity and mortality among neonates in Indonesia. The ex-cessive use of antibiotics may cause antibiotic resistant bacteriaand may cause neonatal fungal infection.Objective To investigate the spectrum of organisms which causeneonatal sepsis and assess their sensitivity to various groups ofdrugs in the neonatal unit.Methods A prospective study conducted on newborn babies de-livered in Cipto Mangunkusumo Hospital, Jakarta from July 2004-May 2005 who presented clinical signs of septicemia were sub-jected for blood culture. Those sensitive to antibiotics for 7 daysyet showed no clinical improvement were also cultured for fungi.Results A total of 499 blood cultures were taken, 320 were posi-tive for bacteria (positivity rate was 65.3%). There were 192 samplescultured for fungi, and the positivity rate was 64% (all for Candidasp). Acinetobacter calcoaceticus was the most common bacteriafound (35.7%), followed by Enterobacter sp (7.0%), and Staphylo-coccus sp (6.8%). Most bacteria showed high degrees of resis-tance to commonly used antibiotics (ampicillin and gentamicin).There were also high degrees of resistance to cephalosporins byboth Gram negative and Gram positive organisms. Only 61.7% ofA. calcoaceticus, and 45.7% of Enterobacter sp were sensitive toceftazidime. Gram negative organisms were also highly resistantto amikacin, but Staphylococcus sp was only moderately resis-tant. Resistance to carbapenem (meropenem and imipenem) var-ied from moderate to low. Drugs which were not used for newbornbabies (quinolones/ciprofloxacin and chloramphenicol) varied frommoderate to high resistance.Conclusion Neonatal sepsis remains one of the major causes ofmortality in our neonatal unit. Most organisms have developedmultidrug resistance, and management of patients infected withthese organisms and especially those with fungi infection are be-coming a problem in developing countries
The use of pediatric logistic organ dysfunction (PELOD) scoring system to determine the prognosis of patients in pediatric intensive care units Dewi Metta; Dedi Soebardja; Dadang Hudaya S
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.1-6

Abstract

Background Prediction of outcome of patients admitted to pediat-ric intensive care unit (PICU) requires an objective tool for measure-ment. It is important to provide information for the patient’s familyand to explain the objectives of intensive care.Objective To evaluate whether the Pediatric Logistic Organ Dys-function (PELOD) scoring system can be used to determine the prog-nosis of patients treated in PICU.Methods A longitudinal-observational study on patients treated inthe PICU of Hasan Sadikin General Hospital was conducted in No-vember 2004-December 2004. The PELOD scoring system wasapplied to all subjects within the first 24 hours of PICU admission.The scoring system consists of physical and laboratory variables of6 organs, namely neurological, cardiovascular, renal, respiratory,hematological, and hepatic systems. The sum of scores were ana-lyzed by logistic regression method to calculate the probability ofdeath. The subjects were monitored until they passed away or weredischarged from PICU.Results There were 32 subjects who met the inclusion criteria. Themean (SD) of PELOD scores in survivors was 13.5 (8.5) and in nonsurvivors was 22.2 (10.1) (Z M-W =-2.507;P=0.012), while the meanof PELOD scores in survivors of PELOD scores validation studywas 31.0, and in non survivors was 9.4. The increase of PELODscores correlated with the increase in the probability of death(P=0.038), and a linear regression chart showed a positive correla-tion (R 2 =0.93). PELOD scores at a 50% probability of death was 20,while the mean PELOD scores validation study was 26. Based onthe probability of death of P<0.5, the death prediction and observeddeath had a sensitivity of 54.5% and a specificity of 80.9%. Amongpatients with high PELOD scores (>20) and those with low PELODscores (<20), the number of patients who survived with extendedlength of stay in PICU, were not significantly different (P=0.15).Conclusions PELOD scoring system can be used to determine thepatient’s probability of death in PICU, but can not be used to predictthe length of stay in PICU
Etiological patterns of bacterial meningitis in neonatal sepsis Andy Setiawan; Idham Amir; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.32-6

Abstract

Background Sepsis and meningitis are major causes of mortalityand morbidity in neonates. The prevalence of sepsis is around 1-4out of every 1000 live births, and one-fourth is accompanied bymeningitis. These numbers are higher in prematures.Objective To find out the prevalence and etiological patterns ofbacterial meningitis in neonatal sepsis, and the pattern of antibi-otic susceptibility for organisms causing bacterial meningitis.Methods This was a cross sectional study, conducted in the neo-natal ward and emergency room at Cipto Mangunkusumo Hospi-tal from October 2003 to October 2004.Results Seventy two neonates fulfilled the inclusion criteria andwere examined for blood and cerebrospinal fluid (CSF) cultures.Sixty out of 72 neonates were proven for sepsis. Bacterial menin-gitis was found in 18 neonates, and all cases were accompaniedby sepsis. Positive CSF cultures were found in 12 neonates. Theother six were diagnosed based on CSF cell count >32/μl.Acinetobacter calcoaceticus was the major causative organismsin this study. The organisms were highly resistant to first line anti-biotics, except for chloramphenicol. They were also sensitive toceftazidime (second line), meropenem, and imipenem.Conclusions The prevalence of bacterial meningitis in neonatalsepsis at Cipto Mangunkusumo Hospital was 18/60 in 2003-2004.The major causative organism was Acinetobacter calcoaceticus.Antibiotic resistance was very high and only chloramphenicol,ceftazidime, meropenem, and imipenem remain effective
The effect of iron versus iron plus zinc supplementation in children with malaria Bugis Mardina Lubis; Danny Dasraf; Nelly Rosdiana; Bidasari Lubis; Munar Lubis; Syahril Pasaribu; Chairuddin P Lubis
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.7-12

Abstract

Introduction Little is known about the potential interaction of ironand zinc given to increase hemoglobin and serum ferritin in chil-dren with malaria.Objective To study the effect of iron compared with a combination ofiron and zinc supplementation on children with falciparum malaria.Method Children with positive Plasmodium falciparum (n=86) wererandomly assigned to a daily supplementation of 6 mg iron/kg perday plus placebo or plus 10 mg zinc per day for 30 days. All childrenwere treated with the same regimen for the treatment of P. falciparum.Venous blood samples were collected at the start and end of thestudy. After 30 days of supplementation, the baseline and follow-upblood samples were analyzed.Results The increase of hemoglobin concentration in the ironplus placebo group was 0.58 g/dl, while in the iron plus zinc groupwas 0.09 g/dl (P<0.05). Serum ferritin concentration was high inboth groups before trial, yet there was no significant differenceafter iron supplementation.Conclusions Iron supplementation showed significant increasein hemoglobin concentration in children with positive P. falciparumtreated with the same regimen of treatment. Supplementation ofiron alone as well as iron plus zinc had been proven ineffective toiincrease serum ferritin in children with malaria.
Clinical profiles and some associated factors of Japanese encephalitis in Bali I Komang Kari; Wei Liu; I Made Kompiang Gautama; I Ketut Subrata; Zhi Yi Xu
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.13-9

Abstract

Background Japanese Encephalitis (JE) is a mosquito-borne vi-ral disease that can affect the central nervous system and causeseveral complications and death. In Indonesia, particularly in Bali,studies of JE in humans are still very limited.Objective To assess the clinical manifestations and outcome ofJE in Bali and to identify some possible associated factors andmonthly distribution of admission to the hospitals.Methods A cross-sectional study was conducted in 8 district hospi-tals, army hospital, and Sanglah central hospital, as surveillance cen-ters in Bali, from July 2001 through January 2003. Subjects less than12 years of age and residences of Bali province who were suspectedof having acute viral encephalitis, aseptic meningitis, and acute flac-cid paralysis referred from all health facilities were included in thisstudy. The diagnosis of JE was established by detection of virus-spe-cific IgM in CSF and serum, with IgM capture enzyme-linkedimmunosorbent assay (MAC ELISA)Results During the study, 158 subjects with encephalitis were in-cluded; 55 (34.8%) were caused by JE and 103 (65.2%) were causedby non-JE. It showed that pig owning and rice farming were signifi-cantly associated with JE (PR= 3.02, 95% CI 1.29; 7.10; P= 0.009and PR= 2.86, 95% CI 1.30; 6,31, P= 0.008, respectively). Mostsubjects (46.2%) were under 2 years old with mean age of 37.24(SD 32.24) months. Forty-two (26.6%) subjects had nuchal rigidity,and all of them had aseptic meningitis. Denpasar had the highestprevalence of non-JE cases. Bangli and Klungkung had the lowestprevalence of JE and non-JE. The highest prevalence of JE was inGianyar. Peak prevalences of JE were in April and May 2002. Peakprevalences of non-JE were during August-October 2001 and inMarch-April 2002. Four (7.3%) subjects of JE group and 25 (24.3%)subjects of non-JE died. There were 25 (45.5%) out of 55 subjectswho survived with disability. Twenty-four (43.6%) JE subjects and34 (33.0%) non-JE subjects had good outcome.Conclusions Around one third of the subjects were positively di-agnosed as JE. The highest prevalence of JE was found in Gianyar.Peak prevalences of JE are in April and May 2002. Pig owning andrice farming are associated factors. Almost half of JE subjects sur-vived with disability
Situational analysis of pediatric residency training program in Indonesia Srisuparyati Soenarto; Ova Emilia
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.20-4

Abstract

Background Over the last twenty years, higher education, par-ticularly pediatric residency training, has changed dramatically. Aquestion arises whether the pediatric residency training conductedin Indonesia today has been set up to meet the changing as wellas the community needs.Objective To evaluate whether the pediatric residency trainingprogram in Indonesia today has met the changing as well as thecommunity needs.Methods Twelve centers with pediatric training program in Indone-sia were involved in this study. Each institution had various numberof respondents, with a total of 42 respondents. A structured ques-tionnaire with open responses was selected to ensure the varietyand flexibility of responses.The questionnaires included statementswhich encompassed areas such as curriculum, training and educa-tional system, and alumni achievement of educational objectives.Continuous content analysis of the responses was made.Results Coverage was considered adequate by 80% of respon-dents and was suggested to be continuously updated to be in linewith existing national problems but not yet considered internationalstandard. Additional knowledge and competence proposed by therespondents are mollecular biology, genetics, generic skills, com-munication skills, and introduction to sophisticated instruments. Thelength of the existing program was appropriate. Graduate knowl-edge was sufficient and fulfilled pediatric standards. Current pro-gram was different from that of the past. The objectives are compre-hensible. The placement of trainees enabled them to follow eachdivision in a spiral fashion (at least three times during the training).Conclusion The curriculum content of the training process wascontinuously updated to be inline with existing national problems.Additional knowledge, and competence, and the present lengthof study was considered appropriate. Graduate knowledge issufficient and fulfills pediatric standards. Furthermore, the objec-tives of the current program are clearer and placement of train-ees enables them to follow each division at least three times
Intestinal permeability of autistic and healthy children as measured by D-xylose test Hardiono D Pusponegoro; Tuty Rahayu; Agus Firmansyah
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.37-40

Abstract

Background The etiopathogenesis of autistic disorder is unknown.Some authors suggest that food peptides may reach the centralnervous system through a defect of intestinal permeability and pro-duce toxic effects resulting in behavior impairment.Objectives To investigate the prevalence of increased intestinalpermeability in children with autistic disorder using oral D-xylosetest.Method A cross-sectional study was conducted on 27 childrenwith autistic disorder and 54 healthy children (27 siblings and 27unrelated children matching with those of the autistic group). Thesubjects underwent oral D-xylose test. Subjects were free fromfever, drugs, and diarrhea. Student t-test and chi-square were usedfor statistical analysis.Results Prevalence of increased intestinal permeability in the au-tistic group was 63%, which proved to be significant (P=0.007,95%CI: -0.931; -0.987) compared to controls.Conclusion The intestinal permeability significantly increased inautistic children
Clinical features of patients with hemolytic anemia due to red blood cells membrane defect Pustika Amalia W; Djajadiman Gatot; Teny Tjitrasari; Iswari Setianingsih; Nanis Sacharis Marzuki
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.41-5

Abstract

Background Hemolytic anemia may result from corpuscular orextracorpuscular abnormalities. One of the types of corpuscularabnormalities is membrane defect. The diagnosis is sometimesdifficult and it may need special hematologic investigations. Thereare no data yet on the clinical features of red blood cell membranedefect in Cipto Mangunkusumo Hospital.Objective To evaluate the clinical features and laboratory find-ings of patients with hemolytic anemia due to red blood cells mem-brane defect in Cipto Mangunkusumo Hospital.Methods This was a descriptive study on patients with red bloodcells membrane defect who came to the Thalassemia Center atCipto Mangunkusumo Hospital during 2002-2004.Results In 2002-2004, there were 241 new cases of hemolyticanemia consisted of 116 patients with beta-thalassemia, 109 withHbE-beta thalassemia, 3 with alpha-thalassemia, and 13 with redblood cells membrane defect. The red cells membrane defect pa-tients consisted of 4 males and 9 females, ranging in age from 1months to 14 years. All subjects came to the hospital due to pale-ness as a chief compaint. Hepato-splenomegaly was found in 5 of13 cases. Laboratory findings revealed hemoglobin level 6.4-13.1g/dl (mean 9.4+2.1 g/dl), MCV 58.4-94.5 fl (mean 81.2+10.2 fl),MCHC 31.7-35.8 g/dl (mean 33.9+1.1g/dl), RDW 15.8-28.4%(mean 20.1+3.6%) and normal hemoglobin electrophoresis. Pe-ripheral blood smear showed anisocytosis, poikilocytosis,spherocytes, ovalocytes, stomatocytes, target cells, and fragmentedcells. The most common diagnosis in this group was SoutheastAsian Ovalocytosis (5/13).Conclusions In facing hemolytic anemia with normal Hb electro-phoresis or normal RBC enzyme level, the possibility of red cellsmembrane defect should be taken into consideration as a causeof this disorder. The clinical features and laboratory findings of redblood cells membrane defect patients are highly variable. Occa-sionally, hematologic investigations are necessary
Coagulation abnormality as a complication of L-asparaginase therapy in childhood lymphoblastic leukemia Djajadiman Gatot; Keumala Pringgardini; Rulina Suradi
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.46-50

Abstract

Background Bleeding, one of the most common symptoms ofacute leukemia in untreated patients, is mostly due to thrombocy-topenia as a result of myeloinvasion by leukemic cells. Neverthe-less, a further contributory factor for the additional hemorrhagiccomplication during intensive chemotherapy is the myelosuppressiveeffect of most active drugs. L-asparaginase, one of the cytostaticsused during remission induction therapy for childhood of acutelymphoblastic leukemia (ALL), is widely reported to impair the he-mostatic system.Objective To determine the influence of shorter courses of L-as-paraginase (L-Ase) on some of the hemostatic parameters in thetreatment of childhood ALL.Methods A prospective analytical study was carried out in theDepartment of Child Health, Cipto Mangunkusumo Hospital Jakartafrom July 1, 1999 to June 30, 2001 on newly diagnosed ALL pa-tients with normal liver function tests treated according to our na-tional ALL protocol which one of its composition contained 6 in-stead of 9 injections of L-asparaginase.Results All of 30 children with ALL included in the study, experi-enced prolongation of prothrombin time (PT), activated partialthromboplastin time (aPTT), and decreased fibrinogen concentra-tion, markedly during the administration of L-asparaginase. How-ever, none of the patients had additional hemorrhage or evidenceof disseminated intravascular coagulation (DIC).Conclusion The use of shorter courses of L-asparaginase, 6 in-jections, in the remission induction chemotherapy of childhood ALLin our department may reduce the blood clotting factors withoutfurther hemorrhage complication or evidence of DIC

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